Three patients of doctors at Strax have died after plastic surgery since 2008

Three people have died after cosmetic surgery performed by doctors at a busy Lauderhill medical practice since 2008 — more than at any other physician office in Florida.

Doctors at Strax Rejuvenation & Aesthetics Institute, where 35-year-old Lidvian Zelaya died after a doctor performed liposuction last month, reported two other deaths in the past three years, according to the Florida Board of Medicine. Doctors at only four other physician surgery offices reported any deaths, none more than one.

In one of the deaths, state health officials have filed disciplinary charges against the doctor who performed the surgery at Strax. A spokeswoman for the medical board, which will hear the case, declined to comment about the deaths or Strax. State health officials took no action in one of the other deaths. An autopsy is still pending in the third death.

In addition, four patients have filed pending malpractice lawsuits against the clinic and its doctors, one by the family of a woman who claims they missed breast cancer that claimed her life.

"One death in a career is really too many, three is definitely too many," said Dr. Randy Miller, president of the Florida Society of Plastic Surgeons. "Even in the best of hands, there can be problems. But that's definitely something that should be looked at."

"This is cosmetic surgery, there shouldn't be any deaths," said Aventura plastic surgeon Leonard Hochstein.

Strax attorney Jay Chimpoulis called the criticism sour grapes by competitors who have lost patients to Strax — a business that says it performed the most cosmetic surgeries among all U.S. physician offices last year by appealing to people other than the wealthy.

The center had no fault in the deaths, Chimpoulis said, and it's no surprise to have complications at a center that has hosted 29,000 operations in the past six years, with a roster of up to 20 surgeons. The complication rate is low, he said, and state inspectors have found no violations at Strax.

"It's not an unsafe place. They don't cut any corners. The state won't let you get away with it," Chimpoulis said. "Strax does provide lower-cost cosmetic surgery but not at the expense of patient care."

Medical outcomes depend on the skill of the surgeons, each of whom is an independent contractor solely responsible "for his own decisions and surgical technique," Chimpoulis said.

Rick Woulfe, an attorney who represents many Strax surgeons, said the doctors were not at fault in any of the deaths.

In addition to the liposuction case, the deaths involved a man who died at home in bed 12 hours after a facelift in 2008 and a woman who died eight days after a tummy tuck in 2009, according to reports that the doctors must submit to the state after serious complications.

Strax has built a bustling practice since 2004 with frequent radio and TV ads promoting bargain prices, such as breast implants for $3,500 instead of the more typical $5,000 to $10,000. Strax also offers lesser-known services such as fat injections called "Brazilian butt lifts" and a female sexual enhancement injection called the G-Spot Shot.

Strax promotes the skills of the surgeons who practice at its offices in Lauderhill and Boca Raton. State records show some of the doctors have been disciplined or sued for malpractice, including:

Dr. Roger L. Gordon: He was the surgeon on two of the recent deaths after procedures at Strax. He also was fined $10,000 and ordered to undergo an evaluation of his practice after two 2004 deaths at now-closed Florida Center for Cosmetic Surgery in Fort Lauderdale. Gordon denies wrongdoing in any of the deaths.

State records show his insurer paid a total of about $700,000 to settle three malpractice lawsuits, two stemming from the 2004 deaths and one by a patient scarred by breast implants. Woulfe said Gordon did not want the insurer to settle the cases.

Also, in 2009, Florida Medical Center in Lauderdale Lakes terminated Gordon's privileges to perform surgery there. State health officials filed a disciplinary action against him in 2009, saying he wrongly told the hospital three times that he had not been disciplined. The case is pending.

Dr. Jeffrey Hamm: The state medical board suspended Hamm's license for three months in 2009, fined him $10,000 and forbade him from doing large liposuctions after a Strax patient nearly died during liposuction.

The woman spent two months in a hospital recovering from kidney and respiratory failure stemming from the operation. The board found that Hamm failed to review tests that showed her unstable diabetes put her at high risk for complications from surgery.

Woulfe said an anesthesiologist and surgical staff also saw the report and were not concerned, but Hamm took the blame.

Also, Hamm's insurer has settled six malpractice cases since 2003 for a total of about $800,000 involving infections and tissue damage after breast implants. Hamm opposed the decisions to settle the cases, Woulfe said.

Of the 16 surgeons now active at Strax, 15 do not carry malpractice insurance, as allowed under state law. Four do not have privileges to do surgery at a hospital, meaning they could not operate if complications sent their patients to a hospital.

The three deaths are not the only issues raised by patients who had surgery at Strax.

A grandmother and her husband sued Hamm and Strax, claiming they missed a breast tumor that led to her death last year at age 53.

Avnel Wideman contended in her 2009 suit that Hamm's aide took her for a mammogram at Strax Institute next door to the surgery office before her breast reduction surgery in April 2006. The test found a suspicious mass, prompting an institute doctor to recommend more tests before surgery. The suit said neither Wideman nor Hamm received the report in the two weeks before surgery, and Hamm did not have the removed breast tissue tested.

The tumor went undetected for 19 months, until Wideman was diagnosed with stage four cancer that had spread to the brain, the suit said. She died last year. The suit is pending.

Strax and Hamm deny any wrongdoing. The surgery practice is a separate firm from the institute, and no one at the surgery center knew about the abnormal mammogram, Strax attorney M. Katherine Hunter said. Hamm did not order the mammogram and had no idea it existed until Wideman became ill, attorney Woulfe said.

In a separate matter, a 69-year-old woman said she sustained three cuts to her liver during liposuction by Gordon in May 2009. Her name is being withheld for medical privacy reasons. State officials reviewed the case and took no action.

The woman had dangerously low blood pressure and was not strong enough to go home after eight hours in the Strax recovery room, according to medical records provided by her family. She was sent to a hospital and diagnosed with internal bleeding that required emergency surgery, one of her doctors said.

The family filed a complaint with the state but did not sue. "I'm just happy she's alive," her husband said.

Chimpoulis said nicking the liver is a known complication during liposuction that was disclosed to the woman in advance.

In another incident, a woman, 31, said Strax sent her to the home of one of its nurses instead of a hospital when she was still partially paralyzed eight hours after liposuction in February 2010. Her name also is being withheld for privacy reasons.

She stayed on the nurse's couch for 36 hours but did not recover. Her mother eventually demanded she be taken to a hospital.

Several cosmetic surgeons and the director of the Florida Society of Ambulatory Surgical Centers said they never heard of sending a patient home with a nurse and would never do so because of the risk to the patient.

Chimpoulis said the woman's problem was a bruised nerve — not a serious risk — and Strax arranged for her stay with the nurse to save her a long drive back to the office for a follow-up exam.

Strax is being sued by three patients who contend their surgeries were botched. The cases are pending, and Strax has denied any fault.

One woman claims she was disfigured during a 2007 upper-arm reduction that the surgeon did not halt despite dangerous swelling. Another woman claims she had to be hospitalized for infection and tissue damage from a 2007 tummy tuck and fat removal by Gordon. A third is suing about problems from a nose job.

Attorneys said more patients would sue except they sign Strax paperwork that includes a clause requiring any disputes be settled by arbitrators instead of a lawsuit. In arbitration, the amounts paid are generally less than in court cases.

Miami attorney Sarah Steinbaum said that because of the arbitration clause, she dropped the case of a Strax patient who developed severe infections from 2009 breast implants that needed surgery and a year to heal.

Attorneys for former Strax clients are challenging the arbitration clause in Florida appeals court.

Chimpoulis said arbitration is better for both sides, because it resolves disputes faster and at a lower cost than lawsuits.

Low-cost and high-volume surgery practices, including Strax, worry the cosmetic surgeons association, group president Miller said.

The risk for patients rises when practices hold down costs by using local-acting sedatives for surgeries that should be done under general anesthesia, Miller said.

Strax advertises $3,500 breast implants, but that includes only a local sedative that would leave patients conscious during surgery. It costs another $350 to be made semi-conscious during the procedure or $1,500 for general anesthesia, according to 2009 price sheets given to patients.

Miller said some patients on local sedatives get very nervous during surgery and may require doses so high that they make breathing difficult and raise the risk of complications.

"These procedures should not be taken lightly. There's a lot more to it than the price," Miller said.

Strax publicist Peter Nasca said the center encourages general anesthesia for patients undergoing lengthy procedures, such as breast surgery or tummy tucks. He said the extra cost has been lowered to $500.

Chimpoulis said it's up to patients and doctors to decide which anesthesia is best, and Strax uses strong safety measures in all cases.

"When someone says things like that, look at what their motivation is," he said.